title: Metabolic emergencies.
abstract: All patients in stupor or coma should undergo blood chemistry studies, including blood gases. The anion gap and serum osmolality must be calculated in all patients. An indwelling catheter to monitor urine content and volume is essential. Electrocardiogram monitoring is indicated in all significant metabolic acidosis, especially for evaluation of intracellular potassium effect and arrhythmias. Repeated arterial monitoring of blood gases and electrolytes is essential with the use of flow sheets. Sodium lactate and Ringer's solution should never be given in an emergency care area. Large doses of insulin (100+ units intravenously) are not necessary or indicated in diabetic ketoacidosis and may be contraindicated and dangerous especially in HHNKC. Intravenous or intramuscular regular insulin after urine tests for glucose and ketones alone should not be given. Urine dilution of serum ketones is useless, and serum dilution may be grossly misleading and contraindicated: arterial studies are much more reliable.
mesh_terms: D000138:Acidosis / Q000175:diagnosis; D001786:Blood Glucose / Q000032:analysis; D016883:Diabetic Ketoacidosis / Q000175:diagnosis; D003937:Diagnosis, Differential; D004573:Electrolytes / Q000032:analysis; D004630:Emergencies; D005026:Ethylene Glycols / Q000506:poisoning; D006801:Humans; D007003:Hypoglycemia / Q000175:diagnosis; D007773:Lactates; D008659:Metabolic Diseases / Q000175:diagnosis*; D000432:Methanol / Q000506:poisoning; D012459:Salicylates / Q000506:poisoning; D014511:Uremia / Q000175:diagnosis
chemical_list: D001786:Blood Glucose; D004573:Electrolytes; D005026:Ethylene Glycols; D007773:Lactates; D012459:Salicylates; D000432:Methanol